Compliance Auditor - SRS

To identify and report coding and documentation practices and make recommendations which assure the accurate reporting and documentation of services provided by entity clinical providers.

Required Qualifications

• 3 Years experience auditing coding and medical record documentation in an ambulatory care setting.
• Experience developing training materials and presenting to a large group of professionals.
• Certified Professional Coder (CPC) - AAPC OR Certified Coding Specialist--Physician-based (CCS-P) - The American Health Information Management Association (AHIMA)

Other Qualification Requirements

• Two years of college or five years working experience in a healthcare environment related to auditing of medical records and CMS compliance.

Essential Functions

• Audits Participates in audit risk assessment for each division/provider to determine trends and helps management identify need for more frequent audits.
• Is able to analyze and create concise reports quantifying and summarizing audit findings.
• Presents the findings to Departments, Divisions, and at the Individual Provider level.
• Adheres to audit schedules and deadlines; prioritizes workload; communicates to management appropriately regarding workload and priority concerns.
• Utilizes internal and professional resource tools to provide quality audit results.
• Performs concurrent audits according to a defined audit schedule to assure that the documentation meets the standards set by CMS, local Medicare Administrative Contractor (MAC) and other third party payers.
• Performs provider quality audits to ensure provider is billing to meet established coding guidelines.
• Client support Provides support to SRS management, physicians, administrative and support staff for coding, documentation and compliance.
• Serves as a resource providing support to SRS management, physicians, administrative and support staff for coding, documentation and compliance.
• Provides support with TES/CM edit resolution at assigned sites and assists with coding related edit questions.
• Provides professional and courteous support to providers, clinical staff, PFS, via email, phone and in-person contact, answering questions and providing supporting documentation for compliance standards.
• Communication and training Effectively communicates audit results to supervisor, manager and/or director as appropriate.
• Provide timely feedback and final resolution of identified issues.
• Schedules and provides 1:1 training to provider to ensure maximum coding compliance guidelines are followed.
• Evaluates the inpatient and outpatient training and coding areas for improvement for assigned specialties and incorporates education specific to the needs of the specialty.
• Develops and maintains tools, guidelines and procedures to assist in provider's understanding of requirements for medical documentation and coding.
• Performs training for new providers with timely feedback on their documentation.
• Compliance Has a thorough understanding of ICD-10 and CPT coding guidelines.
• Protects all work products, working papers, personal lap top, and other related documents and/or portable electronic data systems in accordance with SHC and regulatory privacy and confidentiality guidelines.
• Stays current with Medicare updates and specialty specific professional services updates; communicates changes to management.
• Data collection and reporting Designs and develops reports within a specified timeframe.
• Analyzes trends while reviewing documentation and communicates to management.
• Reports findings identified during documentation reviews and includes official references related to the findings.
• Education Reviews coding publications for changes, clarifications and/or information pertinent to the medical group's specialties/services.
• Attends and participates in job related conferences, seminars and workshops to enhance skills and keep current on coding and documentation changes.
• Presents to management complete supporting documentation associated with areas of concern.

Knowledge, Skills, And Abilities

• Excellent working knowledge of CPT, ICD-10 and HCPCS codes is required.
• Thorough understanding of Medicare, insurance documentation, and compliance and coding requirements.
• Expert knowledge of MS Office which includes: Excel, Word, and PowerPoint.
• Ability to educate and train all levels of clinical and professional staff.
• Excellent interpersonal skills verbal and written, with the ability to communicate to all levels of staff within the organization.
• Ability to produce high quality work/reports with minimal error rate.
• Professional approach to work including ability to exercise mature judgement and maintain confidentiality in all activities.